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The relationship between FODMAPs and thyroid health is a complex and intriguing one. FODMAPS stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. They are a group of often poorly absorbed short-chain carbohydrates found in various foods and sometimes have the potential to trigger digestive discomfort in susceptible individuals. Beyond their association with gastrointestinal issues, there is emerging research showing a possible connection between FODMAPS and hypothyroidism. Understanding how these fermentable carbohydrates can influence thyroid function is relevant for individuals with digestive issues and those navigating the challenges of thyroid disorders. This article explores the interplay between FODMAPs and thyroid health to discover valuable insights into personalized approaches for managing these conditions and improving quality of life.

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Understanding FODMAPS requires first understanding the intricacies of this group of fermentable carbohydrates and each individual acronym.

1. F for Fermentable: These foods are ones that your gut bacteria feed on and convert into a gas via a chemical process called fermentation. For some people, this fermentation process by the gut can lead to bacterial overgrowth, with digestive symptoms like bloating and gas.
2. O for Oligosaccharides: Oligosaccharides – also known as soluble plant fibers – are carbohydrates that feed off the “good” bacteria in your gut. They are found in various foods such as onions, scallions, leek, kale, cabbage, broccoli, garlic, beans, lentils, chicory root, whole wheat grain, and certain fruits like nectarines, pears, and berries. Oligosaccharides play essential roles in the body, particularly in the digestive system, where they act as prebiotics. Prebiotics are a type of dietary fiber that stimulates the growth and activity of beneficial bacteria in the gut. The human body does not easily digest oligosaccharides, so they pass through the digestive system largely intact, fueling the colon’s bacteria. This process has been associated with various health benefits, including improved digestion, enhanced immune function, and a reduced risk of digestive symptoms and diseases like colon cancer.

3. D for Disaccharides: The word “disaccharides” literally means two sugars or double sugar molecules. This includes all dairy products derived from cows, sheep, or goats. Lactose is the fermentable sugar in this group, meaning the sugar found in dairy and human milk. People with lactose intolerance may experience digestive discomfort when consuming dairy because their bodies lack sufficient levels of lactase enzymes to break down lactose efficiently.
4. M for Monosaccharides: If disaccharides means double sugars, then “monosaccharides” means single sugar molecules. Fructose is the fermentable sugar in this group. Foods include honey, dried fruits, fruit jam, canned fruits, and certain fresh fruits such as grapes, apples, pears, kiwis, and bananas. Fructose is usually well tolerated, but some may experience digestive issues because of malabsorption or difficulty absorbing excess fructose in the small intestine.
5. P for Polyols: These are sugar alcohols such as sorbitol, mannitol, xylitol, and maltitol, which are more commonly used as artificial sweeteners in sugar-free products and occur more naturally in certain fruits and vegetables like stone fruit and mushrooms. Because of the slow absorption in the small intestine, polyols can draw water into the bowel and cause gastrointestinal symptoms in susceptible individuals.

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Research has shown that a high FODMAP diet can increase the amount of fluid exiting the small bowl, which may induce motility changes (changes to how the muscles in the bowel contract), distension (or swelling) of the bowel, and diarrhea. People with digestive issues such as IBS (irritable bowel syndrome) and/or bloating may benefit from a low FODMAP diet. A low FODMAP diet is an effective therapy for managing IBS symptoms, decreasing symptoms in 75% of patients, resulting in a 50-80% decrease in bloating following a FODMAP protocol. A low FODMAP protocol has efficacy rates that exceed those of drug therapies, such as antibiotics and prokinetic agents.

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There is a complex influence of FODMAPS on thyroid hormone levels. Some research shows that consumption of certain FODMAP foods might even contribute to fluctuations in thyroid hormone levels, which may exacerbate symptoms of hypothyroidism. This relationship between nutrients, the gut, and the thyroid is conceptualized as the “nutrient-GI-thyroid axis.” Gastrointestinal health can often be seen as the center of thyroid-related care because 1) GI conditions can lower thyroid-specific nutrients, such as selenium and iodine, 2) GI care can improve the status of those same thyroid-specific nutrients, 3) GI conditions are 45 times more common than hypothyroidism, 4) GI care can resolve common thyroid dysfunction symptoms and 5) GI health can affect overall thyroid autoimmunity.

One notable aspect of FODMAPS is their impact on thyroid medication absorption. FODMAPS have the potential to interfere with medication absorption, even outside of thyroid-related ones. It is recommended that medication is taken on its own away from other foods and liquids to increase absorption and help maintain thyroid hormone levels. When there is active inflammation in the gut, it can interfere not just with medication absorption but also with other nutrients from foods. Improving the gut microbiome will help improve thyroid health in the long run.

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People with hypothyroidism may be susceptible to specific FODMAP foods. It is essential to recognize these triggers to help minimize digestive discomfort and optimize overall well-being. This is best done using a personalized and guided approach to identify the foods and eliminate those that may exacerbate hypothyroid symptoms.

One dietary strategy that has gained attention is implementing a low FODMAP diet. To follow a low FODMAP diet, you first eliminate high FODMAP foods from the diet for a specific timeframe, typically around four to six weeks. This elimination phase allows the gut to calm down and reduces symptoms. After this phase, foods are gradually reintroduced in a controlled manner to determine which specific FODMAPs trigger symptoms in the individual. 

High FODMAP foods include fruits and vegetables such as apples, pears, onions, garlic, and artichokes. Dairy products containing lactose, wheat, rye-based products, sweeteners like honey, and high-fructose corn syrup are also high in FODMAPs. During the elimination phase, these foods are replaced with low FODMAP alternatives such as bananas, strawberries, cucumbers, lettuce, lactose-free dairy products, gluten-free grains, and natural sweeteners like maple syrup.

Some potential benefits after adopting a low FODMAP diet for a certain amount of time include a reduction of gastrointestinal symptoms, improved absorption of thyroid medication, and a better regulation of thyroid hormone levels. Low FODMAP can also improve pain, anxiety, and overall quality of life.

It is essential to acknowledge the potential risks and challenges associated with this diet, such as the risk of nutrient deficiencies and the need for careful planning to ensure a balanced and varied diet. It is important to note that a low FODMAP diet should be followed under the guidance of a healthcare professional, as it can be challenging to navigate the complexities of the diet. These professionals can help you identify your specific trigger foods and create a personalized meal plan that ensures adequate nutrient intake.

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Identifying FODMAP triggers in hypothyroid individuals is crucial for personalized dietary management and allows people with hypothyroidism to manage their symptoms and optimize overall well-being. Introducing a low FODMAP diet is a promising strategy that can offer potential benefits such as reduced gastrointestinal symptoms and, as a result, improved thyroid function. However, adopting this dietary approach necessitates carefully considering all potential risks and challenges, which is why we at Paloma encourage collaborating with healthcare professionals.

Paloma nutritionists can play a crucial role in helping hypothyroid patients follow a low FODMAP diet. By providing personalized dietary guidance, they can assist patients in identifying and eliminating high-FODMAP foods that may exacerbate their symptoms.

If you’re curious whether a low FODMAP diet is the next best step for you, contact us at Paloma Health to schedule an appointment with our thyroid-savvy healthcare professionals.

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